Prospective cohort study of child mouthing of faeces and fomites in Dhaka, Bangladesh (CHoBI7 Program)

Abstract

Objective To characterise childhood mouthing and handling behaviours and to assess the association between hand‐to‐object and object‐to‐mouth contacts and diarrhoea prevalence in young children in urban Dhaka, Bangladesh. Methods A prospective cohort study was conducted among 494 children under 5 years of age in Dhaka, Bangladesh. This study was nested within the randomised controlled trial of the Cholera Hospital‐Based Intervention for 7 Days (CHoBI7) mobile health (mHealth) program. The CHoBI7 mHealth program focuses on promoting handwashing with soap and water treatment to diarrhoea patients and their household members through mobile messages and a single in person visit. Mouthing and handling of faeces and fomites among young children was measured by five‐hour structured observation and caregiver reports. Diarrhoea surveillance data was collected monthly for 12 months. Results Fifty five percent of caregivers reported that their child put a visibly dirty fomite (object or soil) in their mouth in the past week. Caregivers reported that 50% of children had mouthed visibly dirty objects, 26% had mouthed dirt, and 2% had mouthed faeces. Forty five percent of children were observed mouthing a visibly dirty fomite during structured observation, 40% of children were observed mouthing a visibly dirty object, 10% were observed mouthing soil, and one child (0.2%) was observed mouthing faeces. Mouthing of visibly dirty fomites was highest for children 12‐18 months of age with 69% of these children having caregiver reports and 54% having observed events. Children with caregiver reports of mouthing faeces had a significantly higher odds of diarrhoea over the subsequent month (Odds Ratio: 4.54; 95% Confidence Interval: 1.06, 19.48). Conclusion These findings demonstrate that mouthing of contaminated fomites among young children is frequent in urban environments in Bangladesh, and that mouthing faeces is associated with a significantly higher odds of diarrhoea. Interventions are urgently needed to protect young children from faecal pathogens in their play spaces.

Fecal Contamination on the Household Compound and in Water Sources are Associated with Subsequent Diarrhea in Young Children in Urban Bangladesh (CHoBI7 Program)

“…36,57 The association identified in our present study is likely because feces on the household compound contributed to fecal contamination of drinking water sources that are often illegal connections to the municipal water supply [58][59][60][61] and contributed to pediatric exposure to fecal pathogens through child mouthing behaviors. [13][14][15][16] High E. coli (> 100 CFU/100 mL) in source water was a significant risk factor for diarrhea in young children in this study. This finding are also consistent with previous studies that have found unimproved and unprotected water sources, which are more prone to fecal contamination, to be associated with pediatric diarrhea.…”

“…[9][10][11][12] Geophagy, the consumption of soil, dirt, or mud, and child mouthing of feces and fomites have been associated with environmental enteropathy, diarrhea, and growth faltering in young children. [13][14][15][16][17] Previous studies have also identified unimproved drinking water sources, poor water storage practices, not treating drinking water in the home, lack of caregiver handwashing with soap, lack of caregiver awareness of hygiene practices,…”

“…44 A second cohort study in this population assessed the association between soil-and object-to-mouth contacts and diarrhea prevalence for children under 5 years of age, and found that the odds of having a diarrhea episode in the subsequent month were significantly higher for children with caregiver reports of mouthing feces within the past week. 16 Additional publications document the CHoBI7 mHealth program effect on handwashing with soap while in the hospital, 45 diarrheal disease knowledge, 46 process evaluation for CHoBI7 mobile health program delivery, 47 and recent formative research to develop a CHoBI7 Baby WASH mHealth program targeting safe child feces disposal, improved food hygiene, and safe child mouthing practices. 48 This prospective cohort study, also nested within the recent CHoBI7 mHealth program RCT, adds to this body of literature by investigating the environmental and individual-level risk factors for diarrheal disease among children under 5 years of age residing in slum areas of Dhaka, Bangladesh.…”

Food Hygiene and Fecal Contamination on the Household Compound are Associated with Increased Pediatric Diarrhea in Urban Bangladesh (CHoBI7 Program)

“…33,34 In addition, unsafe disposal of child feces can lead to fecal contamination in the household compound and diarrheal disease in young children. 35 Most recently, our cohort studies 16,19,21 in Bangladesh and the Democratic Republic of the Congo found child mouthing of contaminated fomites and feces was associated with diarrheal disease among young children in both rural and urban settings.…”

“…[15][16][17] Young children often put surfaces and objects from their environment in their mouth; this is a normal part of their development. 18 Several studies have demonstrated that geophagy-the consumption of soil, dirt, or mud-and child mouthing of feces, fomites, and contaminated hands, have been associated with EE, diarrhea, and growth faltering in young children 16,[19][20][21][22][23] The presence of feces on the household compound and improper waste disposal has been associated with childhood diarrhea. [24][25][26][27][28] Zoonoses can also cause diarrheal diseases among young children, 29 with domestic animals such as birds spreading fecal pathogens in the household environment.…”